Lesbians, HPV, and Cervical Cancer

Managing the calculus of risk

Lesbian couple on bed
Lesbian couple on bed. Tony Garcia/Image Source/Getty Images

There is a growing public awareness that sexually transmitted HPV infections are associated with an increased risk of cervical cancer, and other cancers, but not everyone is aware of how easily HPV is transmitted or how common it is. Because of this, there are groups that may have no idea that they're at risk for HPV infection or associated cancers. Lesbians, historically, have been one of these groups, both because they are often not as engaged with healthcare as heterosexual women and because even doctors generally have a poor understanding of lesbian sex and the risks it may carry for STD transmission.

The proportion of women who have sex with women who know that HPV is transmitted through skin-to-skin contact and can be passed sexually between female partners is far lower than it should be.

Lack of HPV Screening

Awareness isn't the only reason that lesbians and other women who have sex with women are at risk of poor consequences of HPV. One of the reasons that lesbians have historically suffered from higher morbidity and mortality from cervical cancer is that women who don't need birth control are often less proactive about visiting a gynecologist. They may not be aware that they are at risk of STDs or other reproductive health concerns; however, they may also be reluctant to seek out pelvic exams and gynecologic care because of a lack of insurance or a history of negative interactions with doctors.

Without regular gynecological visits, women are less likely to receive appropriate Pap smears.

That means that if and when cervical cancers are diagnosed, they are of a later stage, more dangerous, and more deadly. Improving screening compliance, possibly through the use of HPV tests and self-swabs, may be one way to reduce morbidity and mortality among sexual minority women.

Lack of HPV Prevention

Finally, prevention interventions have not been effectively targeted to young lesbians.

A 2015 study based on national survey data found that lesbians were far less likely to be vaccinated against HPV than were their heterosexual counterparts. In the period between 2006 and 2010, only 8.5 percent of lesbian identified women aged 15-25 had been vaccinated compared to 28 percent of heterosexual women. This likely reflects perceptions of disease risk, at least in part, as evidenced by the fact that vaccination rates among bisexual women were even higher - 33 percent. A study using more recent data found higher vaccination rates but the sample was not representative of the general population, and the reported rates were still lower than for heterosexual women.

Conclusion

Lesbians suffer from a number of health disparities that are linked to cervical cancer risk. Many of these disparities can be traced back, at least in part, to the stigma of being a member of a sexual minority. Others can be traced back to ignorance.

Reducing lesbians' risk of cervical cancer will require a multifaceted approach.

Insurance coverage will need to continue to improve for this historically under-served group of women. Doctors will need to be trained in more affirming attitudes about working with sexual and gender minorities. Finally, women will need to be better educated about the fact that anyone who is sexually active is at risk for HPV. Although most infections will go away on their own, that's still something that everyone needs to be aware of.

Sources:
Agénor M, Peitzmeier S, Gordon AR, Haneuse S, Potter JE, Austin SB. Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls: A National Survey. Ann Intern Med. [Epub ahead of print 21 July 2015] doi:10.7326/M14-2108


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